Has your disability claim been denied or terminated? Call (888) 321-8131 for help!
Ortiz Law Firm | National Disability Law Firm
Ortiz Law Firm is dedicated to helping people recover the disability benefits they deserve. We handle group Long Term Disability (LTD) claims, individual disability insurance policy claims, ERISA disability claims, and Social Security Disability claims.
Marcia L. Smith (“Smith”) worked as a property manager for Arlington Properties, Inc., and starting on March 1, 2016, she was covered under a long-term disability plan administered by United of Omaha Life Insurance Company and Mutual of Omaha Insurance Company (collectively, “United”). The plan provided the following as part of its exclusions: Three months …
Here, Melissa Maher (“Maher”) was Manager of Research and Development at Bonne Bell, L.L.C. (“Bonne Bell”). Her job duties were considered to be light with sedentary demand. Further requirements were the ability to use ten pounds of force and other exertions of lesser amounts more frequently. Because of her employment with Bonne Bell, Maher was …
A dentist from Michigan prevailed on appeal after Provident Life and Paul Revere denied his long-term disability benefits. Although the insurers argued he wasn’t totally disabled because he could still perform managerial duties, the Sixth Circuit affirmed that he was unable to perform the primary duties of his occupation.
Although she initially received long-term disability benefits from Reliance Standard, Lash's claim was later denied under the stricter “any occupation” standard. Lash sued both Reliance Standard and Matrix Absence Management, the plan’s third-party administrator.
The present case involves an ERISA claim for short-term disability and long-term disability insurance benefits where the claimant argues that the administrator improperly denied his claims for benefits. Marc Kouzmanoff (“Kouzmanoff”) was a sales representative for Thompson Reuters Holdings, Inc. (“Thompson Reuters”). In 2001, he developed diabetes; later, in 2016, he applied for disability benefits arguing that his job duties included a …
In this case, the court found that United of Omaha Life Insurance Company failed to evaluate the medical evidence presented adequately. The insurer ignored favorable evidence submitted by her treating physician(s), selectively reviewed the evidence it did consider from the treating physicians, failed to conduct its own physical examination, and heavily relied on non-treating nurses and other non-physicians.
The Court held, “The level of activity or the lack thereof that Mr. Khalil reported to Liberty in support of his claim of continued disability was undermined by the video evidence that Liberty collected during the three years of review.” The claimant’s claim was further undermined by the fact that his own treating physicians ultimately opined that he was not disabled. The Court denied Plaintiff’s Motion for Summary Judgment and granted Liberty’s Motion for Summary Judgment.
On May 8, 2015, United informed Kerridge’s counsel by letter that it had denied Kerridge’s appeal. United indicated that its decision was based on the records from Dr. Wilson and the Cleveland Clinic, the other records in Kerridge’s file, and Dr. Zafar’s report from the IME. Kerridge filed a civil action in Federal Court seeking review of United’s decision.
In this case, Kenneth Baker (“Baker”) was an employee who worked for Dunkin Donuts. Through his employment there, he held a policy for long-term disability benefits. Unfortunately, Baker lost all of his administrative appeals with the insurance companies. He also lost at the lower Federal Court. The opinion below relates to Baker’s appeal of the …
Here, Kelly Ann Tyler (“Tyler”) filed a claim for a breach of disability insurance contract against United States Life Insurance Company and American General Life Insurance Company (together, “American General”). Further, she filed claims for a breach of the covenant of good faith and fair dealing by American General, seeking punitive damages. Previously, Tyler obtained …
Katherine Kochanek (“Kochanek”) worked as an employee of Home Depot U.S.A., Inc. (“Home Depot”). Through her employment, she was covered by the Home Depot Welfare Benefits Plan which included short term disability benefits. Aetna Life Insurance Co. (“Aetna”) served as the administrator of the Plan. Under the Plan, a “disability” is considered to be any …
The fact that Dee was eventually diagnosed with cancer and that her shoulder pain “in retrospect” was caused by her cancer is not material to a determination of whether her medical care providers at the time of the medical treatment suspected cancer.
Lisa Jones submitted a claim for long-term disability benefits under an LTD Plan provided to her by Boeing. Aetna was the plan administrator; Aetna denied the LTD claim. Ms. Jones sued under the Employee Retirement Income Security Act (ERISA) for denial of benefits and breach of fiduciary duty. The district court (lower court) dismissed the …
Jennifer Coats (“Coats”) was employed by Cottage Health Care as a staff nurse. Through her employment, she was able to participate in an employee welfare benefit plan which included coverage for long-term disability benefits. These benefits were funded by Reliance Standard Life Insurance Company (“Reliance Standard”). More specifically, Reliance Standard “shall serve as the claims review fiduciary with …
The court agreed with Doe that Standard's reliance on the DOT description of a generic "lawyer," rather than a job description that fully and accurately encompassed the material duties of Doe's specialized area of legal practice, rendered Standard's decision arbitrary and capricious.
The Second Circuit recently ruled in favor of Hartford in a long-term disability claim involving multiple sclerosis, finding that Hartford's denial of long-term disability coverage was not arbitrary and capricious.
The Court affirmed the district court’s decision granting summary judgment to Reliance Standard on the ground that it did not abuse its discretion in denying the claimant’s long-term disability benefits. In other words, the Court ruled in favor of the insurance company.
The court ruled that Hartford reasonably relied on medical opinions and surveillance evidence in deeming her ineligible for continued benefits, which means Hartford’s decision to terminate LTD benefits was rationally justified and thus is not arbitrary and capricious.
The judge stated that, "the record, the policy, and the Parties’ arguments do not support the assertion that Plaintiff was disabled as of July 2012 (termination of LTD benefits) and August 2012 (termination of LWOP benefits). The Court, therefore, has no alternative other than to affirm Unum’s decision to deny Plaintiff’s benefits.”
In this case, the court agreed with the district court that Hartford’s decision was reasonable and did not amount to an abuse of discretion. The record readily shows that Griffin received a fair and thorough consideration of his claim and that the available evidence reasonably supported Hartford’s conclusion.
Here, Aetna has engaged in multiple procedural irregularities, including conducting a self-serving paper review of the medical files based on the incorrect disability standard, relying on the opinion of a non-treating, non-examining physician without reason, and denying benefits based on inadequate information and lax investigatory procedures, as evidenced by Aetna’s decision not to pursue an independent medical examination and its failure to analyze the specific requirements of Plaintiffs own occupation. These irregularities compounded each other and lead the Court to find that Aetna acted arbitrarily and capriciously in denying Plaintiffs LTD benefits.
Defendant informed Plaintiff that her claim for LTD benefits was denied because the medical information provided did not support restrictions and limitations and did not demonstrate a functional loss. The plaintiff argued that she was not required to submit objective medical evidence to prove her disability.
Disability benefits were paid for approximately one month and then were terminated. The termination letter acknowledged that “a medical condition may exist” but stated that “there must be objective medical information to support disability benefits” under the Plan. However, the court concluded that the decision to deny Godmar’s claim for short-term disability benefits beginning in July was arbitrary and capricious.
After reviewing the administrative record and giving no deference to Provident’s decision to terminate benefits, the court found substantial evidence supporting Provident’s decision to terminate Gilewski’s long-term disability benefits.